Intravenous (IV) access is essential to provide fluids, medications and nutrition to hospitalized neonates. Since the 1980s, peripherally inserted central venous catheters (PICC) have been increasingly used to provide IV access. PICCs can be placed at the bedside without general anesthesia and can remain in place for days or weeks with seemingly minimal mechanical complications. However, complications do occur, including central-line associated bloodstream infections (CLA-BSI), phlebitis, cellulitis, and thrombosis. CLA-BSIs have a significant attributable cost and an associated mortality of up to 20%. The long-term objective of this research is to further develop evidence-based strategies to prevent central-line associated bloodstream infections (CLA-BSI) among infants hospitalized in the neonatal intensive care unit. This proposal builds a multicenter pediatric collaborative to examine the association between catheter dwell time and CLA-BSI in this unique population. Many studies have shown that the longer a catheter remains in the place, the greater the risk of complication. However, healthcare providers assume that the risk of a complication is constant from day to day. We hypothesize that 1) the daily risk of PICC-associated CLA-BSI in children hospitalized in the neonatal intensive care unit (NICU) is not constant, and 2) approximately one month after PICC insertion, a threshold exists beyond which time the daily risk of CLA-BSI significantly increases. This proposal will determine if the risk of PICC- associated CLA-BSI is constant over catheter dwell time, and identify whether a threshold exists beyond which the daily risk of CLA-BSI significantly increases. To complete this project we will perform a multicenter retrospective cohort study to collect and characterize data from seven tertiary care NICUs. We will evaluate risk factors for PICC-associated CLA-BSI, focusing on catheter dwell time as a non-linear independent predictor of CLA-BSI. PICCs are essential to the care of hospitalized neonates, but CLA-BSI have significant mortality and associated financial costs. Neonates may face unnecessary risk from prolonged PICC duration if the risk of CLA-BSI over time is not constant. As PICCs continue to be used widely in other healthcare settings and populations, findings from this collaborative project should stimulate additional studies to improve quality of care and prevent healthcare-associated infections. Our long-term goal is to provide evidence-based justification for instituting preventive measures which could save lives and reduce healthcare costs. PUBLIC HEALTH RELEVANCE: Bloodstream infections are a significant cause of morbidity and financial costs. This project will help to develop evidence-based strategies to prevent bloodstream infections among vulnerable infants hospitalized in the neonatal intensive care unit.